DESCRIPTION (applicant s abstract): Dr. Kenneth Langa is a General Internist and faculty member in the Department of Internal Medicine and the Institute for Social Research at the UM. He gained research experience while earning a Ph.D. in Public Policy at the UC and completing the Robert Wood Johnson Clinical Scholars Program at the UM. During his fellowship training he initiated pilot studies on direct and informal caregiving costs of dementia while working as a Collaborator on the NIA-funded Health and Retirement Study (HRS).His immediate career goal is to obtain new clinical and research skills required for the longitudinal study of cognitive impairment in both clinical and population-based settings; his long-term goal is to lead multidisciplinary research efforts to better understand the social and economic impact of dementia on patients, families, and society. The UM provides a uniquely rich environment to support training in the study of aging and cognitive impairment. Dr. Langa will be mentored by senior faculty in the Institute for Social Research, Medical School, Michigan Alzheimer's Disease Research Center, and School of Public Health. He will benefit from his established collaborations with the principal investigator (Robert J. Willis, Ph.D.) and Co-Investigators of the HRS. The research plan will utilize 6 waves of HRS data (collected between 1993 and 2004) to study the direct and informal caregiving costs of cognitive impairment in a population-based nationally representative sample. The longitudinal design (with up to 11 years of follow-up) and extensive data on socioeconomic status, co-morbidities, and informal caregivers will be used to determine the relationship between severity of cognitive impairment (from mild or pre-clinical to severe disease) and direct and family caregiving costs. Longitudinal models will identify determinants of the incidence and progression of cognitive impairment, as well as nursing home admission and death. Markov models will be developed to estimate the lifetime costs associated with cognitive impairment, and determine the distribution of costs across age, gender, race, socioeconomic status, and public (Medicare and Medicaid) and private payers. This project will better define the economic impact of the growing prevalence of dementia in the United States, as well as the potential benefits of new treatments to prevent or slow the progression of this costly and increasingly common condition.